Reversal of delayed-onset paraplegia with thrombectomy of an interposed graft for the intercostal artery after thoracic descending aortic aneurysm repair

The Japanese Journal of Thoracic and Cardiovascular Surgery : Official Publication of the Japanese Association for Thoracic Surgery = Nihon Kyōbu Geka Gakkai Zasshi
Hidenori SakoEriko Iwata

Abstract

A 78-year-old woman who had previously undergone prosthetic graft replacement of the total aortic arch was admitted to repair a chronic expanding type IIIb dissecting aneurysm. Firstly the patient's abdominal aorta was replaced with a prosthetic graft without any complications, then the thoracicdescending aorta was repaired five months later. Surgery for the thoracic descending aorta was performed with distal perfusion, cerebrospinal fluid drainage, somatosensory evoked potential (SEP) monitoring and reimplantation of three pairs of intercostal arteries. During surgery, SEP showed no significant changes, and the patient awoke without paraplegia three hours after the surgery. However, she developed bilateral complete paraplegia eight hours after the surgery. Reexploration demonstrated thrombo-occlusion of the sidearm graft for reimplantation of the Th10 intercostal artery. After thrombectomy of the sidearm graft, there was gradual neurological recovery and the patient was ambulatory when discharged. Quick treatment to restore the spinal cord blood supply promoted recovery from paraplegia.

References

Feb 25, 1998·Journal of Vascular Surgery·H J SafiJ C Baldwin
Jun 10, 1998·Journal of Vascular Surgery·C W AcherP W Kranner
Aug 14, 2002·The Annals of Thoracic Surgery·Albert T CheungJoseph E Bavaria
Jan 23, 2003·The Annals of Thoracic Surgery·Hersh S ManiarGregorio A Sicard
Dec 12, 2003·The Annals of Thoracic Surgery·Kiyofumi MorishitaTomio Abe
Mar 31, 2004·The Journal of Thoracic and Cardiovascular Surgery·Paolo BiglioliRita Spirito

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Citations

Oct 17, 2007·Journal of Clinical Neurophysiology : Official Publication of the American Electroencephalographic Society·Michael L McGarveySteven R Messe

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